Thursday, February 19, 2009

The Wall Street Journal (2/19, Wang) reports, "Most testing for the US drug industry's late-stage human trials is now done at sites outside the country, where results often can be obtained cheaper and faster, according to a study" published in the New England Journal of Medicine. What "make overseas trials cheaper and faster, [is that] patients in developing countries are often more willing to enroll in studies because of lack of alternative treatment options, and often they aren't taking other medicines. Such 'drug-naïve' patients can be sought after because it is easier to show that experimental treatments are better than placebos, rather than trying to show an improvement over currently available drugs." According to the New York Times (2/19, B7, Singer), the study "raises questions about the ethics and the science of increasingly conducting studies outside the United States -- when the studies are meant to gather evidence for new drugs to gain approval in this country." The study conducted "by several Duke University researchers, suggests an ethical quagmire when drugs intended for wealthy nations are tested on people in developing countries." The researchers "suggest that human volunteers in foreign countries may be unduly influenced with the promise of financial compensation or free medical care to participate in clinical trials. The report, 'Ethical and Scientific Implications of the Globalization of Clinical Research,' also asks whether drug research conducted in developing countries is relevant to the treatment of American patients." Individuals of East Asian origin, for example, have a genetic variance that may reduce the effects of nitroglycerin treatment. The researchers' "review of a US government clinical trials registry and of 300 published reports in major medical journals revealed this: A third (157 of 509) of Phase III trials -- typically the largest and most significant trial in the development of a drug -- led by major US pharmaceutical companies were being conducted entirely outside the United States," HealthDay (2/18, Gardner) reported. "In addition, half of the study sites (13,521 of 24,206) used in these trials were located overseas, with many in Eastern Europe and Asia." On its website, CNN (2/19, Watkins) adds that the researchers "reported one study that found only 56 percent of 670 researchers surveyed in developing countries said their work had been reviewed by a local institutional review board or a health ministry. Another study reported that 18 percent of published trials carried out in China in 2004 adequately discussed informed consent for subjects considering participating in research."